title: Algorithm for probable acute coronary syndrome using high-sensitivity troponin T assay vs fourth-generation troponin T assay.
abstract: BACKGROUND
  Chest pain represents between 5% and 10% of annual visits to emergency departments (EDs) and near 25% of hospitalizations. Characterization of chest pain is sometimes difficult, and strategies should focus on preventing inappropriate discharge of patients with acute coronary syndrome. The goal of our study is to compare negative predictive value of the algorithm in the chest pain unit using the fourth-generation troponin T assay (4GTT) vs high-sensitivity troponin T assay (HSTT).
  
  
  METHODS
  We included 600 patients with probable acute coronary syndrome, who were discharged from the chest pain unit without an acute coronary syndrome: 300 patients in the 4GTT group and 300 patients in the HSTT group. Clinical and laboratory variables were analyzed. All the patients were followed up at 30 days, and the cardiovascular events were recorded.
  
  
  RESULTS
  Major cardiac events occurred in only 3 (1.2%) in the HSTT group vs 5 (1.7%) in the 4GTT group (P, nonsignificant). The negative predictive value was 99% in both groups. Emergency department length of stay was 4.3 ± 2.6 hours in HSTT group vs 10 ± 3.4 hours in the 4GTT group (P = .01).
  
  
  CONCLUSIONS
  The algorithm in the chest pain unit using HSTT showed to have the same negative predictive value as the algorithm with the 4GTT but with a shorter stay in the ED.
authors.affiliation: Chief of Cardiovascular Emergency Care Section, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. drconde@hotmail.com
authors.forename: Diego
authors.initials: D
authors.lastname: Conde
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Costabel
authors.forename: Florencia
authors.initials: F
authors.lastname: Lambardi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D000368:Aged; D000465:Algorithms; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T